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. 2013 Apr;56(8):1085-93.
doi: 10.1093/cid/cis1208. Epub 2013 Feb 13.

Varicella Zoster Virus-Specific Immune Responses to a Herpes Zoster Vaccine in Elderly Recipients With Major Depression and the Impact of Antidepressant Medications

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Varicella Zoster Virus-Specific Immune Responses to a Herpes Zoster Vaccine in Elderly Recipients With Major Depression and the Impact of Antidepressant Medications

Michael R Irwin et al. Clin Infect Dis. .
Free PMC article

Abstract

Background: The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study.

Methods: Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination.

Results: Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P<.005). Similar results were obtained taking into account the time-varying status of depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period.

Conclusions: Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine.

Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials flow diagram of subject entry and evaluation.
Figure 2.
Figure 2.
Bar graph of Depression Substudy varicella zoster virus–specific responder cell frequency (VZV-RCF) results at baseline and 6, 52, and 104 weeks in the 3 groups of vaccine recipients: nondepressed controls (Non-depressed No Rx; n = 30); depressed patients who are not treated with antidepressant medications (Depressed No Rx; n = 12); and depressed patients who are being treated with antidepressant medication (Depressed with Rx; n = 12). Results of the baseline VZV-RCF have been previously published [13] and are shown here for comparison with levels of VZV-RCF at 6, 52, and 104 weeks. There were significant differences at all time points between the “Depressed No Rx” and “Depressed with Rx” participants, but not between the “Depressed with Rx” and the “Non-depressed No Rx” participants (F = 6.2; P < .005; analysis of covariance). Abbreviations: PBMC, peripheral blood mononuclear cell; Tx, treatment; VZV-RCF, varicella zoster virus–specific responder cell frequency.
Figure 3.
Figure 3.
Varicella zoster virus–specific responder cell frequency (VZV-RCF) results stratified by quartiles at baseline and 6 weeks after zoster vaccination in the 101 vaccine recipients of the control population. 1st quartile = those with the lowest baseline levels of VZV-RCF; 4th quartile = those with the highest baseline levels of VZV-RCF. Abbreviations: PBMC, peripheral blood mononuclear cell; VZV-RCF, varicella zoster virus–specific responder cell frequency.

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